Do pain management programs

keep working for compensable

patients? Three year follow up.
Anne Daly Pain Management
Physiotherapy Advisor

16/11/2014

&

Introduction
Australian Pain Society
Gold standard for pain management
Goals
Key points
Network Pain Management
Background
Evaluation
16/11/2014

Australian Pain Society Position Statement

on Pain Management Programs
Multidisciplinary / Interdisciplinary
Based on a biopsychosocial understanding
of persistent pain
Cognitive behavioural paradigm

16/11/2014

Australian Pain Society Position Statement

on Pain Management Programs
Goals

Improve understanding of persistent pain

Improve function despite ongoing pain
Modify perceptions of pain and suffering
Provide coping skills and strategies
Promote self management
Reinstate activities of daily living
Reduce or modify future use
of health care services

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Australian Pain Society Position Statement

on Pain Management Programs
SUCCESS DOES NOT = PAIN REDUCTION
Pain reduction is a goal but pain elimination is not the
expected (or a reasonable) end point

OPEN COMMUNICATION IS KEY

Alignment of goals between all stakeholders

TIME IS REQUIRED
Desired behaviours need time to be normalised
Passive therapies work against this
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Network PMPs

Meet the APS position statement criteria

Geographic distribution across Melbourne
Standardised clinical outcome measures
Education on compensation system

Agreement to focus on

Fast service
Return to work (RTW) & communication
Medication use and Mental health
Future services and treatment

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Evaluation of Network Pain

Medication utilisation
Changes in health care utilisation
Clinical outcome measurement
Occupational outcomes

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Medication utilisation
Prior: 60% were prescribed medication
After: 35% were prescribed medication
Opioids and Sedatives
Neuropathics
Sustained or improved 3 years
after program completion

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Health care utilisation

difference in costs 12 months after PM cf 12 mths before PM

Overall
GP
Physiotherapy
Other allied health

-38%
-36%
-81%
-70%

Psychiatry
Psychology
Pharmacy

153%
41%
52%*

* Due to neuropathic medications being

unavailable on the PBS at the time
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Clinical outcome measurement:

Brief Pain Inventory: Pain Intensity
Pain intensity drops slightly
Not statistically significant, smaller than MDC
BUT function improves and medication
reduces without an increase in pain

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Clinical outcome measurement:

Brief Pain Inventory: Pain Interference
71% reported improvement
12% didnt change
Statistically significant, larger than MDC
Enjoyment, sleep, activity, mood

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Clinical outcome measurement:

Fear Avoidance Beliefs Questionnaire
Physical:

74% improved
13% didnt change
Statistically significant, larger than MDC
Work:

61% improved
12% didnt change
Statistically significant
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Occupational outcomes
Certified as unfit at assessment:
41% were reclassified as fit for..

Certified as fit for some duties at assessment:

50% had increased hours and/or capacity

These changes occurred by discharge and

continued to improve at follow up visits

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Global Impression of Change

92.5 % reported improvement
%

45
40
35
30
25
20
15
10
5
0

change

much
worse

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worse

a little
worse

no
change

a little
better

better

much
better

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Client satisfaction
94% were satisfied
%

70
60
50
40
satisfaction

30
20
10
0
very
unsatisfied undecided
unsatisfied

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satisfied

very
satisfied

15

Service timelines
64% were assessed within 20 business
days of approval by agent
64% had commenced a program within
15 business days of assessment
95% completed their programs

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Do pain management
programs keep working
for compensable clients?

16/11/2014

Evaluation of Network Pain

Medication utilisation
Changes in health care utilisation
Clinical outcome measurement
Occupational outcomes
= EVIDENCE BASED PRACTICE

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